State Detail
Michigan
21 plans reporting · CY 2025
Across 21 plans reporting in Michigan, standard prior authorization denial rates range from 4.2% to 34.9%, averaging 13.7%. Among plans reporting appeal outcomes, 66.3% of appealed denials are overturned. All data is from mandatory CMS-0057-F disclosures for calendar year 2025.
Plan Comparison
| Standard | Expedited | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Plan | Org | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Requests | Approved | Denied | Appr % | Denial % | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
| Blue Cross Blue Shield of Michigan | ||||||||||||||||||||||||||
| Blue Cross Complete of MichiganMedicaid MCO | Blue Cross Blue Shield of Michigan | 243,159 | 158,307 | 84,816 | 65.1% | 34.9% | — | — | — | 1.1% | 98.9% | 5.9 | 4.0 | 11,241 | 9,318 | 1,921 | 82.9% | 17.1% | — | — | — | 0.2% | 99.8% | 1.3 | 1.0 | View source ↗ |
| Blue Cross HMO IndividualExchange Plans | Blue Cross Blue Shield of Michigan | 53,252 | 49,654 | 3,501 | 93.2% | 6.6% | 50 | 64.0% | 36.0% | 0.2% | 0.0% | 0.6 | 0.0 | 1,079 | 1,025 | 54 | 95.0% | 5.0% | 14 | 86.0% | 14.0% | 0.0% | 0.0% | 0.3 | 0.0 | View source ↗ |
| Blue Cross PPO IndividualExchange Plans | Blue Cross Blue Shield of Michigan | 31,549 | 29,453 | 2,001 | 93.4% | 6.3% | 24 | 21.0% | 79.0% | 0.3% | 0.0% | 0.6 | 0.0 | 1,008 | 964 | 44 | 95.6% | 4.4% | 23 | 61.0% | 39.0% | 0.0% | 0.0% | 0.4 | 0.0 | View source ↗ |
| BCN AdvantageMedicare Advantage | Blue Cross Blue Shield of Michigan | 175,680 | 167,837 | 7,841 | 95.5% | 4.5% | 594 | 91.0% | 9.0% | 0.0% | 0.0% | 0.5 | 0.0 | 278 | 236 | 42 | 84.9% | 15.1% | 376 | 95.0% | 5.0% | 0.0% | 0.0% | 1.1 | 1.2 | View source ↗ |
| Medicare Plus Blue PPO (H9572)Medicare Advantage | Blue Cross Blue Shield of Michigan | 800,694 | 766,938 | 33,752 | 95.8% | 4.2% | 2,185 | 88.0% | 12.0% | — | — | 0.7 | 0.0 | 1,751 | 1,501 | 250 | 85.7% | 14.3% | 2,717 | 92.0% | 8.0% | — | — | — | 0.9 | View source ↗ |
| Medicare Plus Blue PPOMedicare Advantage | Blue Cross Blue Shield of Michigan | 800,694 | 766,938 | 33,752 | 95.8% | 4.2% | 2,185 | 88.0% | 12.0% | 0.0% | 0.0% | 0.7 | 0.0 | 1,751 | 1,501 | 250 | 85.7% | 14.3% | 2,717 | 92.0% | 8.0% | 0.0% | 0.0% | 0.5 | 0.9 | View source ↗ |
| Centene Corporation | ||||||||||||||||||||||||||
| Ambetter from MeridianExchange Plans | Centene Corporation | 41,967 | 32,463 | 9,504 | 77.3% | 22.6% | 1,518 | 50.8% | 49.2% | 1.9% | 98.1% | 3.0 | 1.0 | 2,453 | 2,008 | 445 | 81.9% | 18.1% | 106 | 59.4% | 40.6% | 2.5% | 97.6% | 1.0 | 0.0 | View source ↗ |
| Meridian Health Plan of MichiganMedicaid MCO | Centene Corporation | 121,587 | 96,054 | 25,533 | 79.0% | 21.0% | — | 63.0% | 37.0% | 0.1% | 99.9% | 4.8 | 2.0 | 5,773 | 4,676 | 1,097 | 81.0% | 19.0% | — | — | — | — | — | 0.9 | 0.5 | View source ↗ |
| Wellcare Medicare Advantage (H5475)Medicare Advantage | Centene Corporation | 41,090 | 33,357 | 7,733 | 81.2% | 18.8% | 627 | 93.9% | 6.1% | 0.0% | 0.0% | 4.0 | 1.0 | 2,397 | 2,131 | 266 | 88.9% | 11.1% | 71 | 95.8% | 4.2% | 0.0% | 0.0% | 1.0 | 0.0 | View source ↗ |
| Wellcare Medicare Advantage (H2117)Medicare Advantage | Centene Corporation | 17,984 | 14,608 | 3,376 | 81.2% | 18.8% | 320 | 95.3% | 4.7% | 0.0% | 0.0% | 4.0 | 1.0 | 983 | 874 | 109 | 88.9% | 11.1% | 29 | 96.5% | 3.5% | 0.0% | 0.0% | 1.0 | 1.0 | View source ↗ |
| HAP / Henry Ford Health | ||||||||||||||||||||||||||
| Alliance Health and Life Insurance CompanyMedicare Advantage | HAP / Henry Ford Health | 21,521 | 18,645 | 2,876 | 87.0% | 13.0% | 546 | 79.0% | 21.0% | 0.0% | 0.0% | 1.8 | 0.0 | 639 | 555 | 84 | 87.0% | 13.0% | 18 | 94.0% | 6.0% | 0.0% | 0.0% | 0.2 | 0.0 | View source ↗ |
| Health Alliance Plan of MichiganMedicare Advantage | HAP / Henry Ford Health | 80,982 | 70,192 | 10,790 | 87.0% | 13.0% | 2,318 | 82.0% | 18.0% | 0.0% | 0.0% | 1.8 | 0.0 | 2,161 | 1,902 | 259 | 88.0% | 12.0% | 70 | 91.0% | 9.0% | 0.0% | 0.0% | 0.2 | 0.0 | View source ↗ |
| Humana Inc. | ||||||||||||||||||||||||||
| Humana Medicare Advantage (H8908)Medicare Advantage | Humana Inc. | 61,080 | 55,422 | 5,658 | 90.7% | 9.3% | 139 | 64.8% | 35.3% | 0.0% | 0.0% | 1.0 | 0.0 | 1,231 | 1,111 | 120 | 90.3% | 9.8% | — | — | — | 0.0% | 0.0% | — | — | View source ↗ |
| Molina Healthcare | ||||||||||||||||||||||||||
| Molina Healthcare of MichiganExchange Plans | Molina Healthcare | — | — | — | 87.0% | 13.0% | — | 50.0% | 50.0% | 53.0% | 47.0% | 5.0 | 4.0 | — | — | — | 90.0% | 10.0% | — | 46.0% | 54.0% | 57.0% | 43.0% | 1.0 | 1.0 | View source ↗ |
| Priority Health | ||||||||||||||||||||||||||
| Priority HealthMedicaid MCO | Priority Health | 78,548 | 58,759 | 19,789 | 75.0% | 25.0% | 1,346 | 61.0% | 38.0% | 0.0% | 0.0% | 3.4 | 2.2 | 2,616 | 2,279 | 337 | 87.0% | 13.0% | 54 | 59.0% | 41.0% | 0.0% | 0.0% | 2.0 | 0.0 | View source ↗ |
| Priority HealthExchange Plans | Priority Health | 36,916 | 30,432 | 6,484 | 82.0% | 18.0% | 676 | 53.0% | 47.0% | 0.0% | 0.0% | 1.2 | — | 1,232 | 968 | 264 | 79.0% | 21.0% | 34 | 47.0% | 53.0% | 0.0% | 0.0% | — | — | View source ↗ |
| Priority Health Medicare Advantage (H8379)Medicare Advantage | Priority Health | 12,695 | 11,477 | 1,218 | 90.0% | 10.0% | 207 | 69.0% | 17.0% | 0.0% | 0.0% | 2.4 | 1.0 | 683 | 605 | 78 | 89.0% | 11.0% | 52 | 79.0% | 13.0% | 0.0% | 0.0% | 1.1 | 1.0 | View source ↗ |
| Priority Health Medicare Advantage (H4875)Medicare Advantage | Priority Health | 96,478 | 88,570 | 7,908 | 92.0% | 8.0% | 1,272 | 73.0% | 15.0% | 0.0% | 0.0% | 2.1 | 2.0 | 4,640 | 4,230 | 410 | 91.0% | 9.0% | — | — | — | 0.0% | 0.0% | 1.0 | 0.4 | View source ↗ |
| Priority Health Medicare Advantage (H2320)Medicare Advantage | Priority Health | 143,530 | 133,450 | 10,080 | 93.0% | 7.0% | 1,640 | 73.0% | 16.0% | 0.0% | 0.0% | 2.1 | 1.0 | 5,520 | 5,100 | 420 | 91.0% | 8.0% | 478 | 89.0% | 8.0% | 0.0% | 0.0% | 0.8 | 1.0 | View source ↗ |
| UnitedHealth Group | ||||||||||||||||||||||||||
| UnitedHealthcare Community Plan of Michigan (Healthy Michigan/CSHCS)Medicaid MCO | UnitedHealth Group | 80,959 | 73,292 | 7,667 | 90.5% | 9.5% | — | 0.5% | 99.5% | 0.0% | 100.0% | 2.1 | 1.0 | 5,729 | 5,619 | 110 | 98.1% | 1.9% | — | — | — | — | — | 0.3 | 0.1 | View source ↗ |
| Upper Peninsula Health Plan | ||||||||||||||||||||||||||
| Upper Peninsula Health PlanMedicaid MCO | Upper Peninsula Health Plan | 8,920 | 7,150 | 1,770 | 80.2% | 19.8% | — | — | — | — | — | 6.0 | 7.0 | 976 | 940 | 36 | 96.3% | 3.7% | — | — | — | 0.0% | 0.0% | 0.8 | 1.0 | View source ↗ |
Standard Denial Rates by Plan
Appeals Analysis
Plans in the upper-right deny frequently and have high overturn rates — suggesting inappropriate denials.
Similar Denial Rates